Light Care Services Limited Hampshire

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated Inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

We reviewed 7 quality statements for this key question and identified 3 breaches of the legal regulations, including, good governance, Notice of Change and Notification of other incidents.

There were no robust governance structures in place in the service and the leadership team lacked knowledge around the issues and priorities for the service and did not have access to appropriate support and development.

There was no robust processes of management oversight and quality monitoring in place to ensure continuous learning and improvement. Therefore, opportunities to improve the service and learn lessons could be missed. This placed people at risk of receiving poor care and avoidable harm.

People and relatives did not always feel they could speak up or that they would be listened to.

Shortfalls identified in this assessment were not recognised or actioned by the provider. Where concerns and issues were brought to the leadership teams’ attention, they did not demonstrate a realistic understanding of the widespread nature and seriousness of concerns identified and did not provide us with assurances effective actions would be taken to address the issues.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not promote a clear vision, strategy and culture for the service which empowered people and enabled them to make decisions about their own care. Opportunities were not provided to people, relatives and staff to give feedback, and leaders were unable to demonstrate the feedback received was considered to make effective improvements in care provision and the overall running of the service. There was a poor culture within the service, which did not promote learning and improvement.

There were no systems and processes in place to promote a positive culture in the service. The provider failed to demonstrate the vision, values, culture and shared direction of the service to ensure transparency, equity, equality and human rights, diversity and inclusion, and engagement had been considered to help ensure people were placed at the centre of their care.

There was lack of skilled and effective leadership and support for the staff. Evidence provided demonstrated the provider failed to properly plan their strategy for the effective management and running of the service. We found that there was lack of cooperation from leaders who continually failed to provide information we requested. For example, we requested multiple records as part of this assessment however these were not produced by the agreed deadline or at all. These issues impacted the safe and effective delivery of care to people using the service.

The service did not demonstrate they had capable leadership with the right skills and knowledge to ensure people were provided with continued effective and safe care. During discussions with leaders, it was evident the leadership team did not understand the context in which care needed to be delivered in a compassionate and inclusive way.

We identified breaches of the legal regulations and concerns in areas such as safeguarding, safe care, staffing and governance. Leaders had not independently identified and acted on these concerns prior to our assessment. Where concerns and issues were brought to the leadership teams’ attention, they did not demonstrate a realistic understanding of the widespread nature and seriousness of concerns identified and did not provide us with assurances effective actions would be taken to address the issues.

At the time of our visit there was no registered manager in place, the overall running of the service was being undertaken by a relative of the provider who had limited experience, training and knowledge of working in the care sector or of their legal obligations.

Processes of delegation and accountability were unclear, so it was not always evident who was responsible and accountable. The provider had failed to put in place a support system to promote staff morale and monitor and improve performance. There were minimal systems in place demonstrating staff views were considered or listened to. For example, although we were told by the leadership team staff meetings were conducted, we were only provided with records in relation to one staff meeting which was specifically about the issues in relation to the employment of overseas staff. There was no evidence staff were provided with any other opportunities to raise concerns and discuss their ideas about the service.

The provider had not identified care and support plans did not always reflect people’s care and support needs and had not been updated in a timely way or that some aspects of care planning were not in place. This placed people at continued risk of receiving unsafe care and treatment and placed them at risk of harm.

Although people and relatives told us they had contact numbers to call should concerns or issues arise they told us these numbers were not always accessible, and concerns raised were not always listened to or acted upon by the leadership team. A relative said, “I have complained 20 times about the poor care and the lack of well-trained carers that understand dementia, but the manager has never been out to discuss anything with us.” Another relative told us, “The carers are very good once I have trained them, but the management of the company needs to be improved.” A third relative said, “The company is not fit for purpose” they added “there is no courtesy shown from the manager to feedback or show concern about a serious incident that occurred.”

During this assessment we found it problematic to engage with care staff to establish if they felt supported to make suggestions about care and if they felt listened to. This was because we could only gather minimal direct feedback from care staff as the leadership team was unable to provide us with up-to-date staff lists of staff employed and correct contact details. Feedback from one staff member was provided anonymously and implied they were they were scared the provider would find out they spoke with us. They also felt this was a shared concern for all staff working within the organisation.

There were policies and procedures in place relating to freedom to speak up and whistleblowing, however, we were unable to establish if staff were made aware of these policies or if the service acted in occurrence with these policies. Systems and processes were not effective in providing people, relatives and staff with the opportunities to speak up or share ideas and concerns.

The management team told us supervision was provided to staff 3 monthly but was unable to provide evidence these had occurred as described. Therefore, we could not be assured staff were provided opportunities to raise concerns or given support in their role.

The provider did not demonstrate they valued diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. When we discussed with them how they supported the staff team with the current potential changes of their employment, in particular the impact this would have on their overseas staff they were unable to demonstrate they had given any consideration to this.

There were policies in place which supported equality, diversity and inclusion. However, there was no evidence found that these were being followed. We could not be assured all staff felt valued or respected by leaders. We saw no evidence that staff were support in their roles. We could not be assured the leadership team shared information with staff about their rights or protected them against abuse.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes. From discussions with the leadership team including the provider who was also the nominated individual we could not be assured they had a clear understanding of their own, other members of the leadership team and staff members roles, responsibilities and accountability. They lacked understanding of their regulatory requirements and responsibilities.

The leaders failed to identify through audits and provider oversight the issues we identified at this inspection. Including but not limited to, poor medicine and risk management, ineffective management of safeguarding, accidents, incidents and complaints, lack of staff training and support, failure to act on issues and concerns, poor recruitment processes, lack of consideration for staff wellbeing and lack of clear, detailed, consistent and up to date information within people’s care records. There was a lack of clear structure and accountability and this meant there was no clear strategy in place to address areas where improvements were needed.

Just prior to our assessment we found the leadership team failed to keep both CQC and other stakeholders up to date with changes to the service and concerns which had been raised by stakeholders, professionals and people. For example, the provider had failed to inform CQC that they had reinstated the provision of personal care, this meant CQC were unable to monitor and regulate the service provision.

Services registered with CQC are required to notify the CQC of certain changes, including address changes and absence of registered managers. The provider failed to notify us of an address change for the service in a timely manner, this was completed a period after the move had occurred.

At the time of our assessment the service did not have a registered manager in post, and we identified there had been no registered manager in post for a period of 7 months. Light Care has a condition on their certificate of registration, that a registered manager must be in post. The service was not adhering to this condition. Furthermore, the nominated individual, who was also the provider of Light Care was out of the country at the time of the assessment and was unable to provide us with an expected date of return. This meant there was a lack of consistent, effective management oversight and poor systems in place for accountability and good governance.

Registered services are required to have a statement of purpose in place however we found the information within the services statement of purpose was not accurate. For example, although there is no person registered as manager with the CQC for the service, the statement of purpose described the nominated individual as the registered manager, this was incorrect. In addition, the statement of purpose stated the service provided care to people with the service user band of Learning Disabilities, however the service was not registered to provide care to people with a Learning Disability.

During our assessment we found the leadership team failed to Notify CQC of significant events, such as injuries, falls and safeguarding incidents. These are required to allow CQC to complete their regulatory duties and ensure ongoing safe and effective care is provided. This was discussed with the provider who told us they had made attempts to notify CQC of issues and incidents, but systems had not allowed this. We requested evidence of this from the leadership team on multiple occasions however this evidence was not provided. Therefore, the provider was not working in accordance with CQC regulations.

The service did not always fully and openly collaborate with the people who used the service and the people that were important to them. Most people and relatives fed back they did not feel the relationship they had with the leadership team was consistently open and honest and people often felt their concerns and experiences were dismissed.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. The leadership team told us staff would report concerns about people’s health and wellbeing with them so referrals to health and social care professionals could be made. However, the involvement of external health care professionals was not always evident in people’s care records.

Staff and people were not given the opportunities to influence how the service was delivered, and effective systems were not in place to share learning from incidents; the records we viewed did not demonstrate that the service worked in collaboration with people and staff when they raised concerns or shortfalls.

We received only limited feedback from health and social care professionals we contacted as part of the assessment process. However, partners confirmed there had been increased collaborative working with the service due to serious issues which had been identified by outside agencies and stakeholders. Although there had been increased collaborative working these professionals continued to have concerns about the overall running of the service.

We could not be assured processes were effective to help people receive positive outcomes with regards to their care and support. Due to the limited processes, such as audits and quality assurance systems in place it was difficult to fully understand if people had received the care and treatment they required, or if professional recommendations were followed.
 

The leadership team did not evidence continuous learning within the service and had not supported consistent improvement and audits to monitor the quality of the service. The leadership team was unable to share examples of working with external agencies such as the local authority commissioners, to help ensure learning was taken from any incidents and practices.

Leaders told us that they were aware of how to report and investigate events and incidents. However, there was no evidence provided which demonstrated leaders effectively recorded or investigated incidents. There were no systems in place to analyse and identify trends. Therefore, we could not be assured the provider was preventing future incidents occurring.

The leadership team told us surveys had been sent out to people who use the service, but to their knowledge none had been sent back. Surveys were discussed with people and relatives and comments included, “We have not received any surveys from the company to feedback on care provision” and “I have not been asked to give any feedback.”

We were unable to assess the effectiveness of the provider’s processes for investigating concerns and ensuring lessons were shared and acted on, due to a lack of records in relation to such concerns. There was no system of oversight of quality to enable learning and continuous improvement of the service, or credible plan in place to drive improvement.